Influence of baseline severity on antidepressant efficacy for anxiety disorders: Meta-analysis and meta-regression
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Background: Antidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range. Aims: To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD), social anxiety disorder (SAD), obsessive–compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and panic disorder. Method: Fifty-six trials of second-generation antidepressants for the short-term treatment of an anxiety disorder were included. Baseline and change scores were extracted for placebo and treatment groups in each trial. Mixed effects meta-regression was used to investigate the effects of treatment group, baseline severity and their interaction. Results: Increased baseline severity did not predict greater improvement in drug groups compared with placebo groups. Standardised regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95% CI –0.13 to 0.20, P = 0.65) for GAD, –0.06 (95% CI –0.20 to 0.09, P = 0.43) for SAD, 0.04 (95% CI –0.07 to 0.16, P = 0.46) for OCD, 0.16 (95% CI –0.22 to 0.53, P = 0.37) for PTSD and 0.002 (95% CI –0.10 to 0.10, P = 0.96) for panic disorder. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (β = 0.11, 95% CI 0.05 to 0.17, P = 0.001). Conclusions: No relationship between baseline severity and drug–placebo difference was found for anxiety disorders. These results suggest that if the efficacy of antidepressants is considered clinically relevant, they may be prescribed to patients with anxiety regardless of symptom severity.
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Pharmacotherapy and psychological interventions are helpful for many but are not effective for everyone and are insufficient to address common physical health complications such as elevated cardiovascular disease risk.
“Although pharmacotherapy and psychological interventions are helpful for many, these treatment approaches are not effective for everyone and are insufficient to address common physical health complications, such as the elevated risk of cardiovascular disease.”
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Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.593 · Cited by 20,391 · see citing works
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.6.617 · Cited by 12,052 · see citing works
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61611-6 · Cited by 6,006 · see citing works
Morris, S. B., & DeShon, R. P. (2002) · Psychological Methods · doi:10.1037/1082-989x.7.1.105 · Cited by 2,502 · see citing works
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008) · PLoS Medicine · doi:10.1371/journal.pmed.0050045 · Cited by 2,442 · see citing works
Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010) · JAMA · doi:10.1001/jama.2009.1943 · Cited by 2,009 · see citing works
Uncertainty in heterogeneity estimates in meta-analyses
Ioannidis, J. P. A., Patsopoulos, N. A., & Evangelou, E. (2007) · BMJ · doi:10.1136/bmj.39343.408449.80 · Cited by 1,254 · see citing works
Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., Shea, M. T., & Keller, M. B. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.6.1179 · Cited by 963 · see citing works
Size of Treatment Effects and Their Importance to Clinical Research and Practice
KRAEMER, H. C., & Kupfer, D. J. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.09.014 · Cited by 850 · see citing works
Efficacy of treatments for anxiety disorders: a meta-analysis
Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000078 · Cited by 555 · see citing works
Pharmacotherapy for post traumatic stress disorder (PTSD)
Stein, D. J., Ipser, J. C., Seedat, S., Sager, C., & Amos, T. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002795.pub2 · Cited by 519 · see citing works
Spijker, J., De Graaf, R., Bijl, R. V., Beekman, A. T. F., Ormel, J., & Nolen, W. A. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.181.3.208 · Cited by 514 · see citing works
Khan, A., Leventhal, R. M., Khan, S. R., & Brown, W. A. (2002) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200202000-00007 · Cited by 456 · see citing works
Leucht, S., Hierl, S., Kissling, W., Dold, M., & Davis, J. M. (2012) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.096594 · Cited by 451 · see citing works
Pharmacotherapy for post-traumatic stress disorder: Systematic review and meta-analysis
Hoskins, M., Pearce, J., Bethell, A., Dankova, L., Barbui, C., Tol, W. A., van Ommeren, M., de Jong, J., Seedat, S., Chen, H., et al. (2015) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.148551 · Cited by 418 · see citing works
Talbott, J. A. (2006) · Yearbook of Psychiatry and Applied Mental Health · doi:10.1016/s0084-3970(08)70124-5 · Cited by 385 · see citing works
Penninx, B. W. J. H., Nolen, W. A., Lamers, F., Zitman, F. G., Smit, J. H., Spinhoven, P., Cuijpers, P., de Jong, P. J., van Marwijk, H. W. J., der Meer, K. V., et al. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.03.027 · Cited by 354 · see citing works
Soomro, G. M., Altman, D. G., Rajagopal, S., & Oakley Browne, M. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001765.pub3 · Cited by 342 · see citing works
Gibbons, R. D., Hur, K., Brown, C. H., Davis, J. M., & Mann, J. J. (2012) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.2044 · Cited by 271 · see citing works
Cuijpers, P., Turner, E. H., Koole, S. L., van Dijke, A., & Smit, F. (2014) · Depression and Anxiety · doi:10.1002/da.22249 · Cited by 242 · see citing works
Self-citationBarbui, C., Cipriani, A., Patel, V., Ayuso‐Mateos, J. L., & van Ommeren, M. (2011) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.109.076448 · Cited by 216 · see citing works
Multivariate Meta-Analysis of Controlled Drug Studies for Obsessive-Compulsive Disorder
Ackerman, D. L., & Greenland, S. (2002) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-200206000-00012 · Cited by 202 · see citing works
An effect-size analysis of pharmacologic treatments for generalized anxiety disorder
Hidalgo, R. B., Tupler, L. A., & Davidson, J. R. T. (2007) · Journal of Psychopharmacology · doi:10.1177/0269881107076996 · Cited by 178 · see citing works
Is dose escalation of antidepressants a rational strategy after a medium–dose treatment has failed?
Adli, M., Baethge, C., Heinz, A., Langlitz, N., & Bauer, M. (2005) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-005-0579-5 · Cited by 173 · see citing works
Severity of depressive symptoms and response to antidepressants and placebo in antidepressant trials
Khan, A., Brodhead, A. E., Kolts, R. L., & Brown, W. A. (2004) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2004.06.005 · Cited by 115 · see citing works
Roest, A. M., de Jonge, P., Williams, C. D., de Vries, Y. A., Schoevers, R. A., & Turner, E. H. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.15 · Cited by 101 · see citing works
Self-citationBaumeister, H. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.05.025 · Cited by 97 · see citing works
Predictors of Response to Pharmacotherapy in Social Anxiety Disorder
Stein, D. J., Stein, M. B., Pitts, C. D., Kumar, R., & Hunter, B. N. (2002) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v63n0211 · Cited by 88 · see citing works
How to access and process FDA drug approval packages for use in research
Turner, E. H. (2013) · BMJ · doi:10.1136/bmj.f5992 · Cited by 59 · see citing works
Self-citationNewer antidepressants and panic disorder
Andrisano, C., Chiesa, A., & Serretti, A. (2012) · International Clinical Psychopharmacology · doi:10.1097/yic.0b013e32835a5d2e · Cited by 59 · see citing works
Two‐year course of anxiety disorders: different across disorders or dimensions?
Hendriks, S. M., Spijker, J., Licht, C. M. M., Beekman, A. T. F., & Penninx, B. W. J. H. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12024 · Cited by 55 · see citing works
Sugarman, M. A., Loree, A. M., Baltes, B. B., Grekin, E. R., & Kirsch, I. (2014) · PLoS ONE · doi:10.1371/journal.pone.0106337 · Cited by 55 · see citing works
Pollack, M. H., Meoni, P., Otto, M. W., & Hackett, D. (2003) · Journal of Clinical Psychopharmacology · doi:10.1097/01.jcp.0000084025.22282.84 · Cited by 38 · see citing works
Implications of the severity of social phobia
Montgomery, S. (1998) · Journal of Affective Disorders · doi:10.1016/s0165-0327(98)00093-7 · Cited by 37 · see citing works
Efficacy and tolerability of second-generation antidepressants in social anxiety disorder
Hansen, R. A., Gaynes, B. N., Gartlehner, G., Moore, C. G., Tiwari, R., & Lohr, K. N. (2008) · International Clinical Psychopharmacology · doi:10.1097/yic.0b013e3282f4224a · Cited by 35 · see citing works
Khan, A., Bhat, A. S., Faucett, J., Kolts, R. L., & Brown, W. A. (2010) · Psychopharmacology · doi:10.1007/s00213-010-2107-1 · Cited by 13 · see citing works
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Research works printed but not linked: 1
- Fournier JC, Derubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, et al. Antidepressant drug effects and depression severity. JAMA 2010; 303: 47-53.
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McDowell, C. P., Dishman, R. K., Gordon, B. R., & Herring, M. P. (2019) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2019.05.012 · Cited by 385 · see citing works
Physical activity and anxiety: A perspective from the World Health Survey
Stubbs, B., Koyanagi, A., Hallgren, M., Firth, J., Richards, J., Schuch, F., Rosenbaum, S., Mugisha, J., Veronese, N., Lahti, J., et al. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.10.028 · Cited by 324 · see citing works
Gordon, B. R., McDowell, C. P., Lyons, M., & Herring, M. P. (2017) · Sports Medicine · doi:10.1007/s40279-017-0769-0 · Cited by 306 · see citing works
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Kandola, A., Vancampfort, D., Herring, M., Rebar, A., Hallgren, M., Firth, J., & Stubbs, B. (2018) · Current Psychiatry Reports · doi:10.1007/s11920-018-0923-x · Cited by 291 · see citing works
Gomez, A. F., Barthel, A. L., & Hofmann, S. G. (2018) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2018.1472767 · Cited by 125 · see citing works
- Authors
- de Vries, Y. A., de Jonge, P., van den Heuvel, E., Turner, E. H., & Roest, A. M.
- Affiliations
- University Medical Center Groningen (NL)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2016-06
- Volume
- 208
- Issue
- 6
- Pages
- 515-521
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2297210753
- Cited by
- 50
- References
- 36
- Citations by year
- 2025: 6 · 2024: 8 · 2023: 9 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 5
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- TU/e Research Portal (publishedVersion, other-oa)
- TU/e Research Portal (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- TU/e Research Portal (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- antidepressants, anxiety disorders, baseline severity, antidepressant efficacy, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, second-generation antidepressants, placebo response
- MeSH terms
- Antidepressive Agents, Anxiety Disorders, Humans, Severity of Illness Index
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